title: PET-CT and the detection of the asymptomatic recurrence or second primary lesions in the treated head and neck cancer patient.
abstract: OBJECTIVE
  The role of follow-up and the detection of recurrent or new primary disease in cancer management remains to be defined. Specifically, the effectiveness and impact on survival of imaging studies that detects disease before it is symptomatic or noted on exam is unknown.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A retrospective review was performed on a series of head and neck cancer patients (n = 123), at a single institution from February 18, 2004 to July 9, 2007, who had undergone nonstaging 18F-fluorodeoxyglucose positron emission tomography-computing tomography (FDG PET-CT) scans as an integral part of the patient's follow-up after definitive treatment. Each scan (n = 308) was evaluated by a board-certified nuclear medicine physician, and final scan readings from each patient's medical record were reviewed for this study.
  
  
  RESULTS
  Of the 123 patients in the study, 24 (20%) were noted to have asymptomatic lesions (either recurrent or new primaries) indicated on PET/CT (8% of surveillance scans) at an average interval of 35.7 weeks posttreatment. Asymptomatic lesions were detected most frequently at distant sites, with 50% being thoracic, but also included were primary (9%), regional (9%), and other distant (32%) sites. At last follow-up of the 24 patients in whom an asymptomatic lesion was detected, 14 patients have died of disease; 10 patients remain alive, four with disease; and one patient had a subsequent recurrence treated and is currently disease-free.
  
  
  CONCLUSIONS
  PET-CT scanning is an effective tool for detecting asymptomatic disease in patients previously treated for head and neck cancer. Unfortunately, even with early detection of recurrent disease, the mortality rate remains high.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Dunsky
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wehrmann
authors.forename: Medhat M
authors.initials: MM
authors.lastname: Osman
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Thornberry
authors.forename: Mark A
authors.initials: MA
authors.lastname: Varvares
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: PET/CT; recurrent head and neck cancer